Getting it Together

Statewide health-care data system in North Carolina will unite county and state health departments.

North Carolina's local public health organizations are finally catching up with the 21st century. With the state's Department of Health and Human Services (DHHS), they have laid the foundation to roll out a new enterprisewide solution called the Health Information System (HIS).

The HIS will let local public health departments statewide generate reports, reconcile bills and access a host of additional applications that weren't available on the old Health Services Information System (HSIS).

Saber Corp., of Portland, Ore., is the prime contractor on the project, which is valued at $19.8 million for the first 19 months, followed by $4.7 million for a 42-month maintenance and support contract.

Although technology in the health-care business improved significantly since the 1980s, the information system that North Carolina's 85 local health departments use to send data to the state health department is obsolete.

"It's not a robust system," said Daniel Staley, health director of the Appalachian District Health Department (ADHD) in Boone, N.C., and chairman of the state's local health directors' technology committee. "You can't very well build an electronic medical record out of it."

The mainframe-based software isn't much help in complying with the federal Health Information Portability and Accountability Act, because the old system forced operators to enter the same data repeatedly for different purposes, not only wasting time, but also increasing opportunities for error.

Sometimes, Staley said, it seems just plain ornery.

"You have to really think about how to outsmart it to get what you need."

The DHHS designed the HSIS in the early '80s to help its Division of Public Health (DPH) collect data from local health departments to show how they were fulfilling their state contracts. In turn, the DHHS needed this data to deliver reports to the federal government and other grant-giving organizations, said Joy Reed, head of the local technical assistance and training branch at the DPH.

Over the years, at the request of local health departments, the state added a module for local departments to schedule patients and another for Medicaid billing.

"It's a state-run system, and they can only collect the data that the state wants and has fields for," Reed said, adding that pulling more than a few basic management reports is also a tremendous problem, requiring the local agency to wait for state IT professionals to design a query in the mainframe, generate a report and ship back the results.

Some local health departments have made do with the state system. Others, Staley explained, have implemented third-party software for their daily operations, but still rely on batch communication to share the required data with the state.

DIY Too Costly
The ADHD never invested in its own, more modern IT system because it couldn't spare the money.

"Then there's the issue that every time you had a change at the state level, your vendor would have to make a change [at the local level]," Staley said. The resulting delays could set the department back in its data collection and billing.

In preparing its RFPs for the new system, the DHHS drafted four sets of requirements. They included:

the core functions the DPH needs immediately, plus functions that are common to the DPH and the state's divisions of mental health and rural health;

functions unique to the division of mental health;

functions unique to the division of rural health; and

functions the DPH would like, but that aren't essential.

The current implementation covers just the first set, and includes only public health facilities. If funds permit, the DHHS could eventually exercise any of the other three options, possibly bringing the mental health and rural health programs onto the system as well.

As of September 2006, the DHHS and the local health departments were conducting a gap analysis to determine which features in Saber Corp.'s proposed system needed customization. The DHHS and its vendor will establish an implementation timetable once they've agreed on the scope of the customization, Reed said.

The state will also pilot the system for three months with five local health departments, and then roll it out to the other 80. The pilot, however, will be more than a test.

"The day the pilot counties come up," Reed said, "we will flip the switch on the old system and put them on the new system, and they will never go back to the old one."

The local health departments have been earmarking funds for several years for a new statewide system, and those funds have allowed the state to sign a contract with the vendor.

"They're stepping up to the plate because they want to make sure that this time, the system we get is really driven by local needs, but then also allows the state to get the data it needs," Reed said.

But developing and implementing the system will require state funds as well. "That is one of our No. 1 legislative priorities this year, to get that additional state money," Reed said, adding that participants have not yet discussed how they will fund ongoing maintenance and support.

It's appropriate for the state and local health departments to share the costs because both benefit from the collaboration, Staley said. Local health departments don't need to individually evaluate and procure new health-care information systems, and the state doesn't need to build interfaces to a plethora of solutions using different technologies and formats.

"I'm sure the state would love to have to go through 85 different systems to figure out what apples are apples," he observed.

Central Database
Besides transmitting data to the state and doing Medicaid billing, local health departments will use the new system to determine patient eligibility, capture patients' personal data and medical histories, schedule appointments, and run a variety of management reports tailored to their own needs.

Hosted by the state's Office of Information Technology Services, the HIS will include a central database with records for anyone who visits one of the 85 local health clinics. All patient information will become available to anyone with the security credentials to view it. That's important in public health, because it serves a fairly mobile population, Reed said.

"In the current system, if you are seen in one health department today, and then you're seen in another health department tomorrow, they have to create a whole new record for you. There's no master patient information that can be shared from county to county."

For the health departments, a unified database will reduce data entry, saving labor and decreasing error rates. For patients, it will mean better continuity of care.

"If mental health and rural health come online down the road, we're hoping that will also help with continuity and integration of care across different types of county-level providers," Reed said.

As a Web-based system, the HIS will let health department employees enter data from any location with Internet access. "Right now, most of our health departments have one to five people who do nothing but enter information into the current system," Reed said. "If the health department lab does a test, they write those results down on paper and it still goes to the data entry person."

With the new system, anyone who performs a service can enter the related data, alleviating duplicated data entry and helping ensure accuracy. Since the new system will be integrated with other medical databases that health departments use, such as the state's immunization registry, employees will no longer have to enter the same data twice. State and local users will also be able to generate a broad range of reports, designing them as needed.

"So it should also help productivity," Reed said.

One notable element of the HIS project is the way the 85 autonomous local health departments have collaborated with the state, committing money, local resources and people, developing the RFP, reviewing vendor proposals and participating in the gap analysis.

"In a local autonomy state," Reed said, "that's critical for success, and we have had just tremendous support from our locals through this process."